Nursing Diagnoses for Neonatal Abstinence Syndrome

This final blog post will describe some of the problems (physiological, emotional, and social) that nurses look for when they are caring for mothers who are involved in substance use and infants who are diagnosed with NAS. 

Nursing Diagnoses
1. Ineffective Childbearing Process R/T Substance Abuse AEB lack of prenatal visits, mother does not report appropriate pre and postpartum lifestyle because of substance abuse, has limited support systems

This nursing diagnosis describes the mothers impaired ability to safely manage her pregnancy. This relates to her failure to obtain prenatal care before birth, her lifestyle of drug use that cannot safely support an infant, and the possibility that she is not well supported by friends, family or significant others. 

2. Risk for disturbed Maternal/Fetal Dyad R/T substance abuse AEB challenging feedings, mother unable to adequately care for her infant, involvement of social services
This nursing diagnosis describes the possible problems between the mother and infant that may occur after birth. Their relationship may be disrupted by the symptoms of NAS the infant will experience which can be very traumatic for both the baby and the mother. It also involves the mothers inability to provide the care the infant needs. Finally, the required involvement of social services may lead to removal of the infant from the mother's care. This can be traumatic for both the infant and the mother. Watch the video below to see an expectant mother's experience with NAS and her desire to get help for her next infant.

3. Ineffective breastfeeding R/T withdrawal symptoms, neonatal abstinence syndrome (NAS) AEB increased infant crying, infant crying at breast, failure to latch, infant irritability
This nursing diagnosis addresses the potential problems infants affected by NAS may have in breastfeeding. Often, the symptoms of NAS involve excessive crying, irritability and inability to self-calm which infants should normally be able to do in order to begin breastfeeding. Mothers of infants with NAS often have many challenges breastfeeding. Healthcare professionals must be available to help the mother and assist her with breastfeeding.

4. Disorganized infant behavior R/T prenatal substance abuse AEB tremors, jitteriness, hyperactivity, fever, sweating, nasal flaring, respiratory distress, poor feeding, myoclonic jerking, seizures, GI disturbances
This diagnosis describes the challenges the infant may have in adjusting to new life with the onset of traumatic withdrawal syndromes. The symptoms listed above could develop into dangerous conditions such as serious breathing complications, inability to self-regulate temperature, malnutrition, brain damage and extreme fatigue. For more information about symptoms of NAS click here for a link to an earlier blog post.

The challenges faced by the drug-addicted mother and her infant suffering from NAS are extensive and have emotional, physiological and social implications as explained above. Expectant mothers who are addicted to substances must seek support from their local birthing center, primary care provider, addiction support facilities, and other community resources to ensure safe pregnancy and delivery, and to ensure their newborn starts life with the highest quality care and attention.

Support Groups for Neonatal Abstinence Syndrome

This blog post contains some support groups and community resources for individuals or families affected by Neonatal Abstinence Syndrome (NAS). Click the titles of each organization/group to access their website!

For anyone with an infant affected by NAS:

Pediatric Interim Care Center

This organization located in Washington State provides short-term care for infants affected by NAS who require intermediate medical attention but are not ready to go home without medical supervision yet. Although these infants are no longer in need of intensive care in a NICU environment, they can still have dangerous symptoms that parents may not be equipped to handle. For parents, adjusting to caring for an infant is hard enough with out a NAS condition, so this program allows them to receive further support with this difficult change in their lives.

For parents of infants with NAS seeking treatment for substance abuse:
Methadone treatment centers

Women who abuse substances and have recently found out they are pregnant are not advised to "quit cold-turkey" because this is medically dangerous not only for the mother but also for the fetus. Withdrawal symptoms cannot be treated in unborn babies. An alternative for soon-to-be mothers seeking treatment is a methadone treatment program that weans the participant off of their opioid of choice with methadone which is a drug that is easier to eventually stop using. This site has links to methadone treatment centers by state. Don't wait, start now in finding treatment for yourself and your future child!

Drug/Alcohol rehabilitation centers

This website is a search engine for finding certified treatment centers for drug or alcohol abuse. Parents of children already diagnosed with NAS who want to change their lifestyle can search here for treatment programs. This step is extremely important in finding support going forward in your life and the life of your child. 

For adoptive parents of infants with NAS:
Adoptive parent support groups
New parents who have adopted a NAS-affected infant may find it challenging to accept their child's condition, or the situations that lead to it. Adoptive parent groups are incredible resources for adoptive parents to come together and share their experiences. Social events, encouragement, advice and support are often available in groups like these. Search with this website's engine to find a local adoptive parent group that fits your needs!

Apps Related to Neonatal Abstinence Syndrome

The following apps may be useful for healthcare professionals who are working with infants suffering from Neonatal Abstinence Syndrome. The first two are related to scoring and determining treatment pathways based on published research. The second two could be recommended to parents who are dealing with NAS. The first is a feeding reminder and tracking app. Because treatment of withdrawal symptoms involves physical touch and comfort measures as well as medicine, it is important for parents to have reminders about feeding and comfort care. The last app may be helpful for parents who are seeking treatment or support during their recovery. Click the titles below to download each app!

Neonatal Drug Withdrawal Tools
FREE
Created by: Kyle Gunter PharmD BCPS
Category: Medical
"Neonatal Drug Withdrawal Syndrome also known as Neonatal Abstinence Syndrome (NAS) is an ever increasing problem among newborn infants. Recent studies have shown a three fold increase in NAS diagnosis over the past decade. The Neonatal Drug Withdrawal Tools App provides the busy clinician with a tool for treating NAS in a quick and intuitive manner. These protocols are based on published studies and provide an evidenced based method for treating neonatal drug withdrawal in newborns. This app is intended for Pediatricians, Neonatologists, Neonatal Nurse Practitioners, Pharmacists and other Pediatric Health Professionals."

Neonatal Abstinence Scoring Record Mobile App
FREE
Created by: Team Canvas
Category: Health Care & Social Services
"The Neonatal Abstinence Scoring Record mobile app allows hospitals and physicians to complete a medical Neonatal Abstinence Scoring Record using a Smartphone or Tablet. The app covers: System Signs and Symptoms for the Central Nervous System, Metabolic and Vascular Motor and Gastrointestinal. This app allows nurse to make notes and captures signature."

iBaby Feed Timer - Breastfeeding, Nursing, Bottle Feeding & Baby development log

$4.99

Created by: Fehners Software LLP

Category: Medical, Lifestyle

"Designed by and for breastfeeding mothers who want to track when and for how long their baby feeds, including a useful reminder for when a feed is due. It even tells you which breast to start on!

Baby Feed Timer does it all for you!
Tracks breastfeeds, bottle feeds, breast pumps, diapers, sleep, solid food, weight, length, notes and reminders(ideal for recording baby's temperature and medicine given)."

Addicaid

FREE
Created by: Twistor Labs, Inc.
Category: Medical
"Addicaid is a new way to begin or maintain your recovery. We cater to moderation management and sobriety. Find and rate meetings, track your progress with custom daily goals with the support of our intimate community. And when you're done clicking around there, you can stay inspired and motivated with our curated news, videos, and music feed. 

We have both 12-step and alternative support groups in our directory.

App features include:

Meetings
• List meetings so you can read them.
• Map out meetings so you can see them.
• Provides directions so you can get there.
• Save to calendar so you remember to go there.
• Check in to meetings so you can prove you were there.
• Favorite, comment, and tag meetings so people know what you think.

Social
• Comment on member goals to give and get community support.
• Add friends
• Public and private chats 
• SOS Alerts for times of need

Personal
• Journal entries
• Daily check-ins
• Custom goals with audio/text response

Resources
• Hotlines
• Inpatient treatment 
• Spending calculator 
• Eating regimen to reduce cravings 
• Relapse prevention tips"

Internet Resources for Neonatal Abstinence Syndrome

This post lists several informational websites that may be helpful for pregnant or recently pregnant mothers who either have infants at risk for Neonatal Abstinence Syndrome (NAS), or have an infant diagnosed with NAS. 

1. Medscape - NAS background (click here)
This website provides detailed information about the signs/symptoms, causes, and pathophysiology (or disease process) of NAS. The website conveniently lays out a common process of assessment, diagnosis, confirmation, and treatment of NAS. Parents who are interested in how this process works will find this website very helpful to explain some of the procedures or assessments done for their infant by healthcare professionals. 

2. March of Dimes - Risks of NAS (click here)
This website provides an overview of what NAS is, why it is a problem for infants, ways to prevent NAS, signs and symptoms that might indicate NAS, and how it is commonly treated in the hospital. This website specifically highlights some of the dangerous conditions infants can develop from NAS such as low birth weight, breastfeeding problems, seizures, and birth defects. It also emphasizes that quitting "cold turkey" is incredibly dangerous for both the mother and the infant.



3. Substance Abuse and Mental Health Services Administration - Treatment for the mother (click here)
This website is a portal that allows mothers or expectant mothers who are addicted to drug substances to search and find authorized treatment centers and facilities. This is essential in ensuring a healthy life and lifestyle for both the infant and the mother. The mother's health and ability to take care of her infant have incredible influences not only on how well her infant will grow and develop, but may even have an impact on whether she can keep her baby at all! If you are concerned about whether or not your infant may be at risk for NAS or if your infant is already diagnosed, please seek life-restoring treatment through this website to benefit both yourself and your child.

4. The Children's Hospital of Philadelphia - Treatment for the infant (click here)
This website lays out information about  the treatment pathway that would be followed in an NICU setting where an infant diagnosed with NAS would be treated. This provides vital information for parents who might be wondering about the specifics of how their infant will be treated, and what kinds of improvements are essential for discharge. By clicking on the highlighted links within the website, visitors can find additional information. While treatment pathways may not be the same for every facility, this is a common regimen that has been supported by research. Eventually, it may become a universally accepted treatment pathway for infants with NAS. 

References

1. emedicine.medscape.com/article/978763-treatment

2. www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx

3. findtreatment.samhsa.gov/

4. www.chop.edu/clinical-pathway/neonatal-abstinence-syndrome-clinical-pathway